The Patients Who Break Your Heart
From the earliest days of nursing school, when we were taught never to become "too involved" with our patients, we nurses find ourselves balancing precariously on the gossamer thread that separates caring for people and caring about them.
Being only human, of course, we sometimes cross the line despite our best efforts...and the nurse whose restless dreams are unpopulated by the ghosts of past patients must surely be a rare bird indeed.
I'll never forget:
1 ) The 29-year-old mother of four who was dying of cervical cancer. Cervical cancer! How many such ailments are both so easily cured, and so tragic when not caught in time? I cared for her during only a single shift, but something still haunts me about the way her mother sat for hours smoothing her long black hair across the pillow, and the quiet dignity that never allowed one word of complaint, even as the bitter pain of the disease and the heartache of her husband's deportation to Mexico at a time when she needed him most gnawed at her.
Meanwhile, the children played quietly about the room as I performed the tasks which must be done; they seemed to know, somehow, that this was a solemn time, and yet they were polite and curious about what I was doing for their mother. I heard a few days later that she had passed on only a few hours after my shift ended; and my heart cried out angrily for an explanation which has never materialized, even to this day. I think maybe I am not meant to know...only to accept.
2 ) The elderly but still vibrant gentleman who had just been diagnosed with Stage III esophageal cancer and given an estimated six months to live. On the second evening after his diagnosis, he asked my advice on chemotherapy, radiation, and other matters; his mood was genial, and he seemed satisfied after I had presented him with several different options. At that point, he called his family together in his hospital room and talked with them for over two hours, after which discussion he put on his call light and asked me to walk with him around the floor for a short time. This I did gladly, as he was a very pleasant man and I enjoyed talking with him. Then he stopped me short with this six-word sentence: "I'm going to end my life".
Of course, words of caution immediately sprang to mind---"You mustn't think like that", "Don't give up hope, there are still things they can do for you"---but died on my lips as I looked into his earnest eyes. This man meant what he said, and no psych consult, antidepressant drugs, or pleadings would stop him. I knew that as well as I knew my own name. Still, I begged him to reconsider, citing the devastation his suicide would surely wreak on his family and friends. Finally, he said, "All right, I'll think about it...for your sake." I was so happy that he'd decided to hold off on harming himself, I hugged him right there in the hallway, and when I discharged him home the following evening, he reassured me that he would still 'think about it' before coming to any decision.
The next day---or so the local newspaper said---this dignified, self-determined man walked out into his garage and shot himself in the head. And I've never told anyone about the conversation we had that night in the hospital...until now.
These are the patients who break my heart. Who is yours?Last edit by Joe V on Sep 5, '18
About VivaLasViejas, ASN, RN Guide
Joined: Sep '02; Posts: 27,000; Likes: 44,897
RN and blogger extraordinaire; from OR , US
Specialty: 20 year(s) of experience in LTC, assisted living, med-surg, psychNov 8, '07Occupation: Registered Nurse Specialty: Medical and general practice now LTC ; From: CA ; Joined: Feb '01; Posts: 63,978; Likes: 14,916It is amazing the patient's that stay in your mind and the ones that don't
I remember a 3 year old girl I admitted at 1pm and was dead by 8pm very suddenly and shockingly that was over 20 years ago and still fresh in my mind. I remember the 68 year old lady who many times in a week we said was at death's door but rallied round and went home 2 weeks later. A 28 year old woman who everyone said was 'just looking for attention' I ended up aspirating over 3 litres of fluid from her stomach and was in theatre by mid morning with obstruction. Many others I can't remember but many I can
Your article made me think long over my years of evperience and I remember more than I thought, a very thoughtful articleNov 8, '07Joined: Jun '06; Posts: 5; Likes: 19In reply to those patients that break your heart. As long as we are nurses we will have families and patients that break our hearts. The unnecessary destruction of life is never going to end, violence and acts of ignorance or inattention will never end. The best we can do for our patients and ourselves as nurses is to keep faith that we hold the patients in our hands but the Lord holds their souls in His. We can do the best we can for them while we hold them, but when God decides its time, no matter how ideal our circumstances are our best efforts will not be fruitful. I was admitting a youngish 60 year old with angina to CCU one night; we were discussing her admission information, her grand daughter and how much she loved her, she wasn't in any pain at the time. I kept an eye on her seemingly normal rhythm strip on the monitor when suddenly she went into Vtach. We coded her within 15 seconds of the onset, it was a textbook code, everything was done right. She died 24 hours later after 12 more codes. It took me a long time to quit asking why and accept that sometimes things are just simply out of our hands. I've also witnessed the miracles of survival against all odds. There is no explanation other than some things we can fix and some need fixing by the higher authority. The bottom line is that when we as nurses quit having the patients who touch our hearts and souls its time to get out of nursing. If you have become so hard and callous that these people and their families don't touch your heart, its time to leave the profession or move to the office job part of it. I'm not intending to step on any toes here but it seems that those who have the admin end of nursing jobs are out of touch with the real issues of nursing and the stresses it causes. Patient care takes a back seat to paperwork.
I guess thats another topic.Last edit by LUNALU on Nov 8, '07 : Reason: misplaced wordsNov 12, '07Joined: Apr '00; Posts: 24,611; Likes: 35,453working in an inpt hospice facility, i see heartbreak far too often.
i hesitate to share, fearing exposure of my pts/families.
what i can share, however, is i would have fallen apart a long, long time ago, if i didn't have God next to me, at all times.
He truly is my strength and inspiration.
i just can't imagine life (or death) without Him.
leslieNov 12, '07From: US ; Joined: Jan '06; Posts: 13,193; Likes: 17,911Wow, this brought tears to my eyes.
The most heartbreaking, for me, are demented elderly who are treated badly by staff and are aware enough to be frightened and hurt. And those who can not be consoled at all.Nov 13, '07Occupation: Paramedic/LPN Specialty: EMS, ER, GI, PCU/Telemetry ; From: US ; Joined: Jul '07; Posts: 2,287; Likes: 4,694the first patient to break my heart was my first pediatric code. it makes me cry to think about it. i remember her name, the date, what she was wearing, everything. i was a newly graduated medic who worked for a small county. we repeatedly visited the same address to pick up a "clumsy" 3-year-old. her mother couldnt have been older than 19, and dad didnt speak english, but he was always yelling at her in spanish. we trekked this baby girl to the ER with bruises, fractures and bloody noses atleast twice a month. i mentioned to the ED staff that maybe social services needed to be called in. that just made it worse. the mother begged with them not to do anything. she didnt want to be deported. she swore that baby girl was just a clumsy toddler and that no one was hurting her. it was out of my hands. the last time we picked up the baby girl, she wasn't breathing anymore. she had blood coming from every orifice in her body. her mother was screaming histerically in the front yard. i radioed for the police to please hurry. i picked up baby girl in my arms and rushed her to the back of my rig. i did everything i could. PALS was not enough to save her broken little body. i followed her through the ED, contuining compressions with sweat dripping down my face. after an hour of compressions, 6 shocks and 4 rounds of meds, the ED doc came up behind me and said, "allison... you need to stop now. shes gone." i just wanted to hold her and tell her how sorry i was that her life was the way it was. i just wanted to take her pain away. i was so mad at everything.. why couldnt i save her? why didnt anyone else care? she was just a baby!!!! upon autopsy, it was found that she died from a perforated bowel... the day she died, she was sodomized and beaten so badly by her father, that it took her life. i sat in the back of the ambulance that night and cried for baby girl. i prayed that her parents would be put in jail forever and never be allowed to have more children. but when i think about her now... i know that her life with god is better than any life she ever had here.Nov 13, '07Occupation: RN and blogger extraordinaire Specialty: 20 year(s) of experience in LTC, assisted living, med-surg, psych ; From: OR, US ; Joined: Sep '02; Posts: 27,000; Likes: 44,897Allison, that has to be one of the saddest stories I've ever read. Bless you for being there for that little angel's last moments........you probably showed her more kindness than she ever knew in her all-too-brief life.
((((((((Allison))))))))Nov 13, '07Joined: Apr '00; Posts: 24,611; Likes: 35,453allison, i would have to say that this little girl's death, was indeed, a blessing.
i can't imagine wanting to be saved, to go home to what?
or maybe a foster parent, if someone will take you?
she would have likely ended up a product in the division of youth services.
she truly lived with the devil.
and God took her home.
thank you, for being her angel.
leslieNov 14, '07Specialty: ICU,PCU,ER, TELE,SNIFF, STEP DOWN PCT ; Joined: Sep '07; Posts: 128; Likes: 148I was a new Medic. Pt was a young man on a motorcycle hit by car. Blind now, trauma, and begged me not to let him die, and I promised him he wouldn't. He died in the ER as he clung to my uniform shirt and was intubated, getting ready to go to OR He had a 2 year old son I found out later.
The woman who had been shot in a multiple homicide as I treated her and watched the light and life fade from her eyes.
The peds codes, no matter what you do is never enough.
The hospice pt with cervical cancer who I made friends with , when she let no one else in.
The man from Vietnam, I had transported taken care of several times, spoke no English, but still comunicated with and was told in broken english by his wife and adult son I would always be in their heart and mind and given a small heart and brain as a gift.
The lady with RA, who gave me a medal to watch over me always.......
There are so many in 17 years I recall and some I wish I couldn't.Last edit by Medic04 on Nov 14, '07Nov 14, '07Occupation: RN and blogger extraordinaire Specialty: 20 year(s) of experience in LTC, assisted living, med-surg, psych ; From: OR, US ; Joined: Sep '02; Posts: 27,000; Likes: 44,897Quote from Medic04:yeahthat:There are so many in 17 years I recall and some I wish I couldn't.Nov 14, '07Occupation: RN Specialty: 15 year(s) of experience ; Joined: Oct '02; Posts: 4,763; Likes: 845I remember a hospice pt who was close to death. He was a very sweet man. He said he needed to hear singing, and asked the CNA and me to sing for him. I don't know how we came up with our choice of song, but we sang that old Lennon Sisters song- "Mr. Sandman."
I remember our voices cracking with emotion as we sang.... and that sweet man slipped peacefully away.Last edit by Hellllllo Nurse on Nov 15, '07Nov 14, '07From: US ; Joined: Jan '06; Posts: 13,193; Likes: 17,911Hellllo nurse, now I'm crying.
What a song to go out to. And what a pleasant ending.Nov 14, '07Occupation: RN and blogger extraordinaire Specialty: 20 year(s) of experience in LTC, assisted living, med-surg, psych ; From: OR, US ; Joined: Sep '02; Posts: 27,000; Likes: 44,897That story reminds me of a resident at my current workplace, who had been on hospice for several months and was dying.........verrrrrrry..........sloooooooooowly. ...............the deterioration was so hard to watch.
Finally, she fell into a coma, and her daughter and I were talking at her bedside as a hospice volunteer came into the room and set up a harp, got out her music, and began to play. It wasn't two minutes into the mini-concert that a slight smile flitted across the resident's lips, and then her entire body seemed to sigh with relief as she slipped away into the next world.
It was without a doubt the most peaceful, and even beautiful, death I've ever witnessed. And as corny as this may sound, I still think of it as the day Mrs. L went to Heaven to the strains of the music of the angels.